Tiniest infants may face problems

The lowest birth-weight babies often face difficulties over time, researchers find.

July 23, 2005|By Judith Graham, Chicago Tribune

CHICAGO -- Even when they escape devastating complications such as cerebral palsy or mental retardation, the tiniest of premature babies -- those weighing 2 pounds or less at birth -- often have significant "invisible" disabilities when they enter school, researchers reported this week.

Many of these children have cognitive or emotional delays and problems communicating, according to a study published in the Journal of the American Medical Association. These "micro preemies" also often need special help in classrooms, are delayed academically and have trouble interacting socially with their peers as they begin to mature.

The findings confirm a disappointing reality: Although doctors save more tiny babies than ever before, medicine has not succeeded in improving future outcomes for many of these children.

"What we're seeing is the long-term implications of more smaller babies and less mature babies surviving. And they are enormous," said Dr. Maureen Hack, the report's lead author and a professor of pediatrics at Case Western Reserve University.

Her study is the first to follow a group of extremely low birth-weight infants born in the United States in the 1990s from infancy to their school-age years.

The 1990s witnessed revolutionary advances in caring for these babies, including surfactant therapy, which helps babies' lungs mature, and steroid therapy, designed to accelerate lung development and help prevent brain hemorrhages.

As a result, about 70 percent of 23,000 super-small infants born each year in the United States survive, up from 49 percent in the 1980s.

In an April report in Pediatrics, Hack and her collaborators laid out the outcomes for extremely tiny babies by the time they reached 20 months of age. For those born in the 1990s, overall rates of neurodevelopmental impairment -- severe cerebral palsy, blindness, deafness or mental retardation -- were 36 percent, up from 26 percent for babies born in the 1980s.

Her new study in JAMA extended those findings by tracking 219 "micro preemies" to age 8, when they had entered school.

It found that many subtle impairments are common, in addition to complications of prematurity documented in the past, such as cerebral palsy and blindness.

Indeed, excluding children with such neurosensory handicaps (an estimated 16 percent), more than half of the remaining children were living with a "functional limitation" at school age. These included cognitive, emotional or physical delays (34 percent) and trouble communicating or understanding instructions (40 percent), among others.